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Critical Thinking – Clinical Judgment (Nursing)

by Christy Davidson

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    00:01 Welcome back everyone.

    00:03 Nursing care has certainly progressed since the days of Florence Nightingale.

    00:06 In fact, Florence Nightingale herself was a pioneer in the beginning stages of the advancements of infection control and healthcare by using one important skill - critical thinking.

    00:17 In nursing, critical thinking for clinical-decision making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care.

    00:32 Critical thinking is more complex than the everyday thoughts that fill our heads.

    00:36 Critical thinking implies an active application of analysis to thought processes.

    00:41 Now, there are a number of standards related to critical thinking and questions people may pose to themselves to aid in the critical thinking process.

    00:49 First, clarity.

    00:50 Clarity is simply the ability to think clearly and logically and to express and understand an idea in more than one medium such as in the spoken or the written word.

    01:01 For example, if new guidelines are being developed, the steps involved and the supporting evidence should be clearly outlined.

    01:07 In seeking clarity, one might ask for more information or examples.

    01:12 Accuracy is carrying out tasks and treatments correctly, obtaining evidence from appropriate sources and evaluating the evidence appropriately.

    01:21 For example, hospital policy may require marking a surgical site in advance with permanent ink to ensure the surgery is conducted on the proper site.

    01:30 In seeking accuracy, one might ask how to verify or test information.

    01:35 Precision is taking the time to follow steps exactly.

    01:39 If for example, the nurse fails to check insulin dose with the second nurse, an error may go unnoticed.

    01:45 Lack of precision often occurs as a result of healthcare personnel being rushed or attempting to take shortcuts in procedures.

    01:52 In seeking precision, one might ask for more specific details.

    01:58 Achieving relevance means sorting through all of the available information and data and determine which is relevant to the situation at hand.

    02:07 For example, when assessing a patient with a stabbed wound, the fact that that the patient is homeless is not relevant.

    02:12 This does not mean that the homeless condition is irrelevant, it may be very relevant to the police or to his general health but it's simply not relevant to this particular assessment.

    02:23 In seeking relevance, one may ask how this information relates to the problem at hand.

    02:30 Depth - sometimes what people do is superficial.

    02:34 Dealing with the problem at hand without looking deeper at the cause.

    02:38 But healthcare providers must always try to look at the complexity of a situation to determine root causes.

    02:44 For example, if an adolescent is repeatedly hospitalized for failing to take asthma medications, stabilizing the teen and sending her home without trying to determine the underlying reason for her failure to take medications does little to solve the problem.

    02:58 In seeking depth, one might ask what factors are involved in this problem and what is the best way to seek solutions? Breadth.

    03:06 Situations may be very complicated in medical care, so one should look at the breadth of a situation from numerous perspectives rather than just looking from one perspective only.

    03:17 For example, a person dying of cancer may want a "Do Not Rescucitate" order while the spouse or the children may be adamantly opposed.

    03:25 Now, while an adult patient has the right to make this decision, family dynamics usually require that the feelings of other members also be considered.

    03:33 Now, the healthcare provider may be in the position to provide support and really help people arrive at a decision.

    03:39 In seeking breadth, one might ask if other perspectives should be considered or perhaps even alternative actions.

    03:48 Logic Logic is simply the application of reason and following of logical steps.

    03:54 For example, the nursing process is followed in a logical progression from assessment to diagnosing the problem to planning an intervention to implementing the plan and then finally, to evaluating the results.

    04:07 Conclusions are arrived at by reviewing the evidence.

    04:10 In seeking logic, one may ask if something makes sense or if it seems logical.

    04:16 Significance Some information or actions are more critical or significant than others.

    04:21 The healthcare provider must be able to exercise reasonable judgement about the significance of the information.

    04:27 For example, if a patient receiving a transfusion suddenly shows signs of anaphylaxis, stopping the transfusion immediately is far more significant than reporting the reaction to the physician.

    04:38 Issues related to significance are very common in nursing.

    04:42 In seeking significance, one might ask what the most important problem or central issue is.

    04:48 Fairness is being open to new ideas and willing to consider new or different approaches.

    04:54 Many of the problems in healthcare derive from the unwillingness to make changes.

    04:58 People become really familiar with procedures or processes and they don't want to learn new ways of doing things, even if they're better.

    05:03 For example, a switch to computerized charting will decrease the incidence of medication errors but it's going to require the healthcare personnel to learn to use the new system and to learn new ways to chart information.

    05:14 Now, while this change would impose a burden to the staff, applying the principles of fairness meant that the benefits to the patients outweigh the inconvenience to the staff.

    05:23 In seeking fairness, one might ask if selfishnes or personal views are interferring with fairness to others.

    05:31 Problem solving Decision making and development of guidelines often begin with the review of the literature.

    05:37 Healthcare providers must read critically using care to evaluate the evidence while keeping an open mind to other possibilities.

    05:45 The first step in the critical reading is to consider the source of the material.

    05:49 Juried medical journals or peer-reviewed nursing journals are always a more valid source than the popular press.

    05:55 Now while this is not a guarantee that the information is correct, having the material reviewed by a number of different people really helps ensure that the most journal or articles are based on solid research and that the reasoning is sound.

    06:09 Next, you're gonna review the author's credentials.

    06:11 Ask yourself these questions, Who is the author or the authors? Is it a reporter? A nurse? A doctor? A researcher? Once you always review the author's credentials to determine if the person is an expert in the field of study.

    06:25 Determine the central thesis.

    06:27 The thesis or central claim of research should be clearly stated in the introduction.

    06:32 One way to quickly evaluate an article or book is to read the introduction and the conclusion before the body of the text.

    06:38 The conclusion usually provides the summary of the thesis and the main supporting points.

    06:42 This is also a quick and efficient way to determine whether the material is worth reading for the purpose of study or it should be eliminated.

    06:50 Examine the organization and methodology.

    06:53 The methodology used to research or reach conclusion should be clearly outlined.

    06:57 If the article or book is based on a particular theory, this should also be stated.

    07:01 The organization of the article itself should also be reviewed to determine if it corresponds with the usual practice.

    07:07 Ask yourself these question: Does it have a clear introduction? Is it organized in a logical manner? Is there a concluding summary? Is the language and terminology appropriate for the intended reader? And next, review the evidence.

    07:22 Evidence is critical.

    07:24 The evidence provided should always support the main points of the article.

    07:29 And finally, evaluate.

    07:31 The overall article should be evaluated to determine if the content seems credible and useful.

    07:36 During evaluation, all the other steps in the critical review of the literature should be considered in determining if the article is sufficiently valid.

    07:44 So remember, critical thinking includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgements and safe decision making.

    08:03 So, in thinking of what we've learned today, I'd like you to consider this question.

    08:07 When conducting a review of the literature, what are the most important steps to follow? You're going to consider the source, you're going to review the author's credentials, determine the central thesis, examine the organization and methodology of the study, review the evidence, and then fully evaluate the article to see if it makes sense for you.

    08:33 I hope you've enjoyed today's video on critical thinking.

    08:35 Thanks so much for watching.


    About the Lecture

    The lecture Critical Thinking – Clinical Judgment (Nursing) by Christy Davidson is from the course Professionalism (Nursing).


    Included Quiz Questions

    1. Critical thinking
    2. Intellectual reasoning
    3. Methodological deduction
    4. Deductive problem solving
    1. Precision
    2. Clarity
    3. Relevance
    4. Depth
    1. Depth
    2. Logic
    3. Breadth
    4. Fairness
    1. Critical care intensivist
    2. Critical care nurse
    3. Emergency medicine physician
    4. Nurse educator
    1. A national government health agency
    2. A blog
    3. Social media
    4. Local physician's office

    Author of lecture Critical Thinking – Clinical Judgment (Nursing)

     Christy Davidson

    Christy Davidson


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